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The revolving door

Sep 9, 2019 • 15m31s

Inside the Royal Commission into Victoria’s Mental Health System, a place that is dysfunctional, inflexible and underfunded.

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The revolving door

75 • Sep 9, 2019

The revolving door

[Theme music starts]

ELIZABETH:

From Schwartz Media, I’m Elizabeth Kulas, This is 7am.

The Royal Commission into Victoria’s Mental Health System has heard evidence of dysfunction, inflexibility and underfunding. It’s also heard personal accounts of what it is like to care for someone with a long term mental illness. Thornton McCamish on the people who are trying to stop the revolving door.

A warning: This episode contains discussion of mental illness and self-harm.

[Theme music ends]

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Archival tape -- Unidentified man:

“I'm putting my hand up to say we cannot accept these failures any longer. We've got to get the answers to make it better and a royal commission is the way forward.”

Archival tape -- Unidentified man:

“The Andrews Government has admitted the mental health system is failing thousands of acutely ill people.”

Archival tape -- Unidentified Woman:

“It's been something like four and a half thousand submissions to this commission I wonder whether or not you made one of them.”

Archival tape -- Unidentified Woman:

“It's really difficult. When you have all those waiting times and having that difficulty accessing help.”

Archival tape -- Unidentified Woman:

“This is a very very... kind of once in a lifetime opportunity isn't it?”

Archival tape -- Unidentified Woman:

“Yes we very much see that it is a once in a generation for the four commissioners, our staff, and all of those who are involved. Our expert advisory panel and others. To really seize this moment and make sure that we give due consideration to the full range of issues that will help to improve our system for the future”

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ELIZABETH:

Thornton, you've attended some of the hearings of the Royal Commission into Victoria's mental health system which started back in March. What were some of those hearings like?

THORNTON:

The hearings were conducted on the second floor of the Melbourne Town Hall. This is it at ah...in the Yarra room. I was struck by the formality of the surroundings. It's a gorgeous old room which is I think used for weddings and corporate functions as much as anything. And I couldn't help reflecting as I looked at those sort of bearded old mayors on the wall that things have really come a very long way.

ELIZABETH:

Thornton McCamish is an author. He wrote about the Royal Commission in the latest issue of the Monthly.

THORNTON:

You know it's a much more modern proceeding than they knew in their time, I think. We're looking at a system now that is much more diverse and open and the proceedings you know took place, not just in that room, but they also went out to Thornbury to meet with Indigenous people and out to the western suburbs for a couple of days.

ELIZABETH:

And what's the nature of the conversation or the evidence that's given by individuals who are called to give oral testimony to the Royal Commission?

THORNTON:

Well there were two different kinds, there are community witnesses who are the ordinary people who have had some personal experience of mental illness or of trying to seek help on behalf of somebody else. And then there are these so-called expert witnesses, who are people who run services, or academic experts or sort of government bureaucrats who are trying to operate the system.

I was struck by the tone of the hearings. There was nothing inquisitorial about them. You know there was no combative cross-examination from counsel assisting. It was really conducted very carefully and warmly. There were counsellors on hand available to anybody, any witnesses, but also anybody in the public gallery who was affected. And then the commissioners themselves sort of spoke about how much they appreciated the courage of people who come in and were prepared to share really personal and painful details.

ELIZABETH:

Let’s talk about one of the stories that was shared with the Commission on one of the days that you attended?

THORNTON:

One of the most affecting ones came from a woman called Mary Pershall, who came to the Royal Commission to talk about her daughter Anna's experience over a very long time in and out of mental health facilities and treatment.

She began by describing her daughter - her memories of Anna - who was just small a delightful little happy child with a really vivid imagination who would invent fantasies about the spiders she would find in the school grounds. She really struggled to make friends as a little girl but her parents hoped that as she grew up she would find her peer group and she'd be okay.

As it turned out she ended up facing a sort of lifelong struggle with with various conditions, I think. Mary sort of lost her composure only momentarily as she recalled that particular incident where a police officer was called to her house for a violent episode and it's just it's interesting that it's kindness that sometimes breaks you down. Because they’d had a lot of trouble getting the help they needed. And you know there's just one random police constable who really understood what they were all going through, I think.

ELIZABETH:

Hmm.

THORNTON:

And she explained how Anna's condition deteriorated as she became addicted to synthetic cannabis and the family just found itself unable to cope with the crisis as they escalated. There was one occasion, Mary said, when they managed to persuade Anna to try detox but they were told that they'd have to wait 10 days for an assessment. And as Mary said it was just useless because the family had barely been able to keep her time for 24 hours focused on the idea of some kind of treatment, let alone you know for another week. Anna realised that she was desperate for help but she was afraid of retribution from her dealers if she contacted police directly. So she came up with a scheme where she entered a service station in Footscray and politely asked if she could use the restroom. Then she stripped naked and stood in the door where everyone could see her. So the police were called, the police took her to a psych ward and a week later Anna discharged herself - and the family wasn't informed or consulted.

ELIZABETH:

And what did Mary say about what must have been incredibly upsetting for her family that they weren't given any notice that their daughter had checked herself out of a psych ward?

THORNTON:

Well it was just a... a turn of tremendous frustration and I think that that for all these years of contact with the system there just wasn't the continuity they needed. That each time they dealt with a new service. They would have to explain where they'd come from they'd have to justify why they were there and it just makes it really hard to get the treatment going in any sort of coherent long term manner. That was the message I think she was trying to give the commission.

Another episode that comes to mind is another admission to a psychiatric unit which ended too soon because there just weren't enough beds available so Mary told the commission how she went in and found Anna really distressed and crying. Um...Mary knew that Anna wasn't capable of looking after herself at that point outside residential care, and she also knew that she and the family were not capable of giving her the care she needed.

Anna was saying to her you know I need this help I need the help they're giving here but the person in charge had said you can't have a bed here just because you want it. So Mary said she begged herself for Anna to be let to stay and she was told that if she cared so much about her daughter why didn't she just take her home. Um so I mean I want to stress uh you know a lot of the testimony you hear stories about really terrific and sympathetic and empathetic people working in a system that is just not working.

But there obviously are moments too where people are under stress and it's just a lose-lose for everybody.

ELIZABETH:

And then Mary says that a certain point they get a call from the police…

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THORNTON:

She'd told the Royal Commission that she had always expected a call to say that their daughter was dead. But what instead happened was they got a call to say that Anna had killed someone else. It happened in November 2015 and Anna was 28 then - she was also four months pregnant. And according to Mary she'd been trying really hard to keep healthy and stay well. But by then her psychiatric condition was such that she was hearing voices in her head telling her what Mary described as terrible things, and Mary said I think her brain just imploded. Anna had fatally stabbed her 67 year old housemate, and friend as I understand it, a man called Zvonimir Johnny Petrovsky in a row over cigarette money.

And so Anna is now serving a 17 year sentence for murder.

ELIZABETH:

We’ll be right back.

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ELIZABETH:

Thornton, you’ve sat in on the RC into Victoria’s mental health system while Mary Pershall has given evidence of her daughter Anna’s illness. Anna killed a friend during a psychotic episode. Do you know how she’s been since she was sentenced?

THORNTON:

Well Mary said that her daughter is improving and actually doing better than she has for a long, long time. And I think that's partly to do with the routine that comes with prison life and the fact that she gets her meds you know every day. She is also tutoring some of the other women in the prison for their academic work. She has a mental health plan and now she knows about what she's dealing with it, she's been diagnosed with schizoaffective disorder with borderline traits. I mean Mary's message was you know that society might say that someone like Anna is a mentally ill person who's addicted to substances and you can just throw her under the bus. But it's never just that one person is suffering there is all the people around them. And in this tragic case you know the victim of the crime. Anna’s sister Katie is caring for and his child. And she said something similar. After the hearing she said ‘what happens is the people trying to care for that person like my mom and dad and me they end up completely exhausted and traumatized. And at the end of their rope.’ And that's what we're seeing today.

ELIZABETH:

And so what was some of the things that Anna’s family, her sister and her mother shared that they hoped might change as a result of this Royal Commission?

THORNTON:

So Mary was emphatic that more safe and supported crisis accommodation is crucial for someone like Anna. And in that she's merely repeating what a lot of experts have told the royal commission. You know this clearly had a really serious problem in Victoria about inadequate numbers of beds for acute patients in particular. She also said that there needs to be a team approach to caring for people with long term mental health conditions and that families need to be listened to.

And I think it's the continuity that's one of the main issues for people that over years and years you can just be dealt with by different teams and then you have to go back to the start and you know you have to go through the admissions process which is exhausting and difficult for people who are not in a great state of mind as it is. But she believes that with the right support someone like Anna really can contribute. Of course the treatment and care for someone like her is going to cost a lot of money. But she pointed out that it cost an awful lot of money to keep people in prison. And there are a lot of other people in Victorian prisons right now who were there for similar reasons to Anna.

ELIZABETH:

And what is all the other stories and experiences that the commission is hearing?

THORNTON:

Well what is striking to anyone who even glances through the transcripts is just the sheer scale of the mental illness problem and also the bewildering variety of suffering that it causes. Tragically.

The figure that people give now is that one in five adult Australians experience some form of mental illness every year. In 2017, more than 3000 Australians took their own lives and the figures just become more alarming when you look at the presentations to emergency departments for example. In the last decade, apparently people presenting with a mental health crisis has increased by 60 per cent in what I thought was perhaps the most remarkable statistic that I have seen in testimony, a Victorian Police Assistant Commissioner told the inquiry that police now attend a mental health incident every 12 minutes in Victoria. So a picture was I guess has emerged of a dysfunctional inflexible and really under resourced system that's just not coping with the scale of the demand.

The impression I get is that as the community care model has become worn down and underfunded and as the population has grown, it's the crisis cases that have become the focus of attention. There's a massive ‘missing middle’ I think is a phrase that was used at the Royal Commission for people who are suffering from depression or anxiety, who just aren't sick enough to get treatment.

ELIZABETH:

Or they might get assistance out of an acute crisis but then they're not given longer term assistance to avoid that happening again.

THORNTON:

That’s exactly right. That's the revolving door thing which the Royal Commission heard a lot about as well. So people who do get treatment but then because they don't have somebody who's monitoring them over a period of years or staying with them. When they start to get ill again, instead of getting the treatment they need to avert a crisis, they end up just plunging back into the crisis and then they're re-presenting the emergency department.

ELIZABETH:

Funding is a huge part of this. What do we know the commission is thinking at present, on that front?

THORNTON:

Well we'll know more about that when the royal commission delivers its interim report in November. Well at the moment we know that Victoria is spending less per capita on mental health and addiction services than any other state in the country. And I think one of the reasons a royal commission has been called is to sort of draw a line under this funding over the last 10, 15 years and say look, what's it gonna cost to rejig the system, make it actually work. So the Royal Commission’s just been given open site to come up with recommendations and Premier Andrews has said he will accept all recommendations. He said in some public remarks I think before the commission started that it may well be that it’ll cost a billion dollars in Victoria to, to get the system that we need.

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You yearn for a solution where you can just treat people and send them home again. And everything’s okay but it's just not part of the health system that works like that. So. It's an area where politicians are going to have to persuade us that it's worth investing in this and being patient and building up a really much better system than we have now.

ELIZABETH:

THORNTON Thank you so much for speaking with us about this.

THORNTON:

Pleasure. Good to be here.

ELIZABETH:

If you or someone you know needs support, you can contact Lifeline on 13 11 14.

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[Theme music]

ELIZABETH:

Elsewhere in the news, in an interview with the NIne newspapers, Scott Morrison has indicated he is considering a national roll out of the controversial cashless welfare card. The program quarantines 80% of a person’s welfare payment and has been criticised by welfare advocates for entrenching disadvantage. In the same interview Morrison recommitted to drug testing trials for people on Newstart and Youth Allowance. Morrison said both programs were part of his “compassionate conversative” approach to welfare.

And 47 bushfires are burning in Queensland, including in the Gold Coast hinterland where 11 houses have been lost. Warnings were in place yesterday for Applethorpe, Stanthorpe, Binna Burra and Beachmont.

This is 7am. I’m Elizabeth Kulas. See you Tuesday.

[Theme ends]

The Royal Commission into Victoria’s Mental Health System has heard evidence of dysfunction, inflexibility and underfunding. It has also heard personal accounts of what it is like to care for someone with a mental illness. Thornton McCamish on the people who are trying to stop the revolving door.

Guest: Author and writer for The Monthly Thornton McCamish.

Background reading:

Spiralling admissions in The Monthly
The Saturday Paper
The Monthly

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7am is hosted by Elizabeth Kulas. The show is produced by Emile Klein, Ruby Schwartz and Atticus Bastow. Our editor is Erik Jensen. Our theme music is by Ned Beckley and Josh Hogan of Envelope Audio.

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75: The revolving door